DAILY NEWS BULLETIN LEADING HEALTH, POPULATION AND FAMILY WELFARE STORIES OF THE Day Tuesday

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1 DAILY NEWS BULLETIN LEADING HEALTH, POPULATION AND FAMILY WELFARE STORIES OF THE Day Tuesday Dengue Dengue cases shoot up in Delhi over past week (Hindustan Times: ) of year s 243 infections in 7 days; end of rains may lead to spike The national capital s annual tryst with dengue may have been delayed this year because of persistent rains, but with 106 cases being reported in the past week (ending September 15) alone, the first entirely dry week in almost two months, healthcare workers and experts say they expect to see an increase in the number of infections soon. Thus far this year, 243 dengue cases have been reported, according to the latest report by the South Delhi Municipal Corporation (SDMC), which compiles infections data after taking inputs from three other corporations: New Delhi, East Delhi and North Delhi municipal corporations. October and November are usually the peak dengue season. Last year, 1,177 dengue cases were reported in Delhi by the third week of September. In 2016, the number was 804. So far, the number of cases of dengue and indeed all the three mosquito-borne illness that are usually reported from Delhi is less than previous years, but the numbers might go up, said a municipal health official on condition of anonymity. The dry spell may be the reason behind the sudden spike in numbers over the past week. When there is continuous rainfall, the mosquito larvae get washed away. It is usually during the dry spells after the rainfall when there is a lot of water accumulation that the breeding starts, said Dr Sarala K Subbarao, former director of National Institute of Malaria Research and former consultant on vector-borne diseases with Indian Council of Medical Research.

2 For the past 10 days or so, there has been no rain in Delhi; this may be the reason why the numbers have gone up now, she added. The numbers might also be less this year because of the milder strain of dengue DENV 3 virus which has been in circulation for three years now. With the same serotype of dengue in circulation for the last three years, immunity in the population may have built up, said Subbarao. This could be a reason why dengue cases having the same serotype are low this year, she said. The number of cases of vector-borne diseases reported from an area depends on several variables -- the amount and intensity of rainfall, the strain of the disease, etc. The strain has remained the same since 2016; in 2015 Delhi saw its worst-ever dengue outbreak that affected nearly 16,000 people and killed 60. That year, the deadlier DENV 2 and 4 strains which are associated with internal bleeding and a drop in platelet count were in circulation. Civic officials said they are carrying out outreach and awareness campaigns like they do every year to combat mosquito breeding. The corporation is leaving no stone unturned to ensure breeding control measures like spraying of insecticides and (ensuring) cleanliness. The domestic breeding checkers (officials who carry out door-to-door visits to warn and fine people over water accumulation) are making regular visits to sensitive areas to ensure no mosquito breeding takes place, said Adesh Gupta, mayor of the north corporation.

3 The corporations also reported 13 cases of chikungunya during the week, taking the total to 60, and 30 cases of malaria, taking the total to 225.

4 Prepared for dengue, say govt, civic bodies (Hindustan Times: ) NEWDELHI: The Delhi government and the three civic bodies have claimed that they are well prepared to deal with increase in the number of the mosquito-borne illnesses this year. With 106 cases being recorded in a single week, the number of dengue cases has almost doubled in the week ending on September 15, the weekly report on vectorborne diseases by the municipal corporations of Delhi has revealed. The government had, earlier, asked all hospitals run by it to earmark beds for patients suffering from dengue, chikungunya and malaria most cases of which are recorded following the monsoon showers. Nearly 1,000 beds are earmarked for fever cases in Delhi government hospitals and will be made available for patients as and when the numbers go up. The hospitals and the clinics are also well stocked with diagnostic tests equipment and medicines, an official from the Delhi government s health department said on condition of anonymity. The government had also issued a circular, wherein they relaxed norms for private hospitals to increase the bed strength for treating dengue patients between August and November. The circular allows private hospitals and nursing homes to increase their bed strength by 10-20%. It has been observed that increased number of cases of dengue, chikungunya and malaria are being reported. It is likely that the number of cases may increase during the monsoon season. Therefore, timely action needs to be taken, the circular reads. According to Delhi Nursing Homes Registration Rules, 2011, all hospitals and nursing homes in Delhi have to follow a strict floor to bed ratio; hospitals have to provide 80 square feet space for one bed and 60 square feet for every additional bed in a ward, not including space for toilets. These norms are relaxed during the monsoons every year since 2015, when Delhi witnessed its biggest ever dengue outbreak, which affected nearly 16 thousand people and claimed 60 lives. The increased number of beds can be used only to accommodate fever patients who are likely to have the mosquito-borne disease, the circular states, adding that the patients must be charged only 50% of the lowest tariff category of the hospital. This year, the government has started an awareness drive while the MCDs are ensuring breeding and spraying of insecticides across the city.

5 Dengue (Dainik Jagran: )

6 Dengue (Hindustan: ) _i_2.pagezoomsinwindows.php Heart Disease Aspirin does not reduce heart attack, stroke risk (The Hindu: ) Says a study involving over 19,000 people Taking aspirin daily does not reduce the the chance of heart attack or stroke and has no benefit in prolonging life free of disability, a study has found. Aspirin-related compounds have been used for the treatment of pain since the 16th century BC, when it was reported that people chewed on the bark of willow and papyrus. In three studies, involving over 19,000 people, published in the New England Journal of Medicine, researchers showed that daily low-dose aspirin (100 mg), when initiated in otherwise healthy people from age 70 onwards, has no benefit in prolonging life free of disability, or substantially reducing the risk of having a first heart attack or stroke.

7 Gender Testing (The Asian Age: )

8 Obesity (The Asian Age: )

9 Obesity (The Asian Age: )

10 Asthma (The Asian Age: )

11 Diet/ Nutrition Probiotics may help battle antibiotic resistance (Medical News Today: ) The latest study to investigate probiotics concludes that regular use may reduce the need for antibiotics. The authors hope that this might help mitigate the rise of antibiotic resistance. Could probiotics help reduce our reliance on antibiotics? Added to a range of products, including yogurts, chocolate, and potato chips, probiotics are never far from the headlines. According to their proponents, these live strains of yeast and bacteria can help rebalance the bacterial flora naturally found in our gut, imparting a wealth of health benefits. These potential benefits vary widely, and, it is important to note, not all are backed by scientific studies. However, there is good evidence that probiotics can relieve acute infectious diarrhea, and there is growing evidence that they might even help reduce the symptoms of some psychiatric conditions, such as depression and obsessive-compulsive disorder. Research into the benefits and risks of probiotics is still in its infancy but it now seems likely that they will one day be medically useful and widely used. Because the importance of gut bacteria is now evident, the race is on to understand exactly how they can be influenced to benefit health. Probiotics and acute infections Interventions that are as simple as eating a yogurt are attractive to consumers and physicians alike; however, when meddling with something as complex as the microbiome, gathering and interpreting the data can be challenging. Gut bacteria come in many forms, and they influence many systems of the body; and not everyone responds to probiotics in the same way. All of the above make drawing solid conclusions about their benefits difficult. Concerns raised over prebiotic and probiotic safety Among the health claims for probiotics, a study asks whether we know enough about the risks.

12 Existing evidence suggests that probiotics can reduce the risk of developing certain respiratory and gastrointestinal infections. Probiotics also seem to reduce the length of time that an infection lasts. The latest study, published in the European Journal of Public Health, takes these findings one step further. The scientists wanted to uncover whether consuming probiotics regularly might also reduce the need for antibiotics. To bolster the existing evidence, they dipped into data from recent studies; their paper is the first systematic review to explore the relationship between probiotic use and antibiotic use. In all, their review found 12 relevant randomized controlled trials, all of which investigated daily doses of Lactobacillus and Bifidobacterium on infants and children. Following analysis, the scientists concluded that infants and children who took a daily probiotic supplement were 29 percent less likely to be prescribed antibiotics. When they repeated the analysis using only the highest-quality studies, that figure jumped to 53 percent. Reduce antibiotics with probiotics Senior investigator Dr. Daniel Merenstein, from the Department of Family Medicine at Georgetown University School of Medicine in Washington D.C., believes that the results could have wide-ranging implications. "Given this finding, potentially one way to reduce the use of antibiotics is to use probiotics on a regular basis." Dr. Daniel Merenstein This study only looked at acute infections in younger people so, as lead study author Sarah King explains, "More studies are needed in all ages, and particularly in the elderly, to see if sustained probiotic use is connected to an overall reduction in antibiotic prescriptions." If confirmed, the findings could be important. She goes on, "[T]his could potentially have a huge impact on the use of probiotics in general medicine and consumers in general." Aside from further explorations that examine other age groups, the researchers also want to delve into the nuts and bolts of this relationship; Dr. Merenstein explains one such theory, saying, "We don't know all the mechanisms probiotic strains may leverage." "But," he continues, "since most of the human immune system is found in the gastrointestinal tract, ingesting healthy bacteria may competitively exclude bacterial pathogens linked to gut infections and may prime the immune system to fight others." There are around 2 million cases of antibiotic-resistant infections each year in the United States, resulting in 23,000 deaths. Finding ways to reduce antibiotic resistance is urgent; perhaps probiotics might offer some valuable assistance.

13 Kidney Disease Study overturns what we know about kidney stones (Medical News Today: ) Current treatments for kidney stones are limited and sometimes painful. Research is changing what we thought we knew about their composition and behavior, suggesting that one day, we may fully dissolve them "right in the patient's kidney." Kidney stones can vary in size and texture and are made up of calcium layers, similar to other sedimentary deposits in nature. In the United States, an estimated 1 in 11 people have kidney stones. They affect more men than women; more than 10 percent of men develop them, compared with 7.1 percent of women. Though generally harmless, kidney stones have been associated with more serious conditions, such as obesity, diabetes, and high blood pressure. Passing kidney stones can be extremely painful. The stones are primarily made of a substance called calcium oxalate, which was believed until now to be insoluble in the kidney. However, new research suggests that this may not be the case. Drawing knowledge from the fields of geology, microscopy, and medicine and using many advanced technologies, a new study finds that kidney stones can and do, in fact, dissolve. The new findings reveal additional information about the nature and composition of kidney stones, running against the understanding of kidney stones that has prevailed for centuries. Mayandi Sivaguru, an associate director at the Carl R. Woese Institute for Genomic Biology at the University of Illinois at Urbana-Champaign, is the first author of the paper, now published in the journal Scientific Reports. 'A minute-by-minute record of kidney health' Sivaguru and colleagues used a combination of the latest optical techniques to study thin sections of kidney stones. They explain that many of the visualization techniques used in this study are common in geology and geobiology but have never been used to examine mineralizations in vivo. Certain antibiotics increase kidney stone risk People who take oral antibiotics may be at higher risk of developing kidney stones.

14 One technique used super-resolution nanometer-scale auto-fluorescence microscopy allowed the researchers to view slices of kidney stones at a resolution of 140 nanometers. A nanometer is a billionth of a meter. The analysis revealed that kidney stones are made of "alternating organic matter- and mineral-rich nano-layers" of crystals. Moreover, these layers are "strikingly similar" to other ancient sedimentary deposits, such as "marine stromatolites, ooids, and oyster shells and pearls," among others. Co-lead study author Bruce Fouke, a professor of geology and microbiology from the University of Illinois, explains what the findings mean, saying, "In geology, when you see layers, that means that something older is underneath something younger. One layer," he states, "may be deposited over the course of very short to very long periods of time." So, "Instead of being worthless crystalline lumps, kidney stones are a minute-by-minute record of the health and functioning of a person's kidney," adds Prof. Fouke. "[J]ust one rock represents a whole series of events over time that are critical to deciphering the history of kidney stone disease." Dissolving stones 'right in a patient's kidney' Importantly, the study also revealed that some of these layers had degraded, uncovering "disrupt crystals." The images showed that new crystals had started to develop, suggesting that kidney stones "undergo multiple events of dissolution as they crystallize and grow within the kidney." In other words, kidney stones cyclically dissolve and grow back, says co-lead study author Jessica Saw, an M.D. student at the Mayo Clinic School of Medicine in Rochester, MN, and a Ph.D. student at the University of Illinois. "Before this study," she claims, "it was thought that a kidney stone is just a simple crystal that gets bigger over time. What we're seeing here is that it's dynamic. The stone is growing and dissolving, growing and dissolving. It's very rich with many components. It's very much alive." This contradicts a belief that has been held for centuries: that kidney stones are homogenous and essentially insoluble in vivo. "Contrary to what doctors learn in their medical training, we found that kidney stones undergo a dynamic process of growing and dissolving, growing and dissolving," Prof. Fouke explains. "This means that one day we may be able to intervene to fully dissolve the stones right in the patient's kidney, something most doctors today would say is impossible." Prof. Bruce Fouke

15 "These observations," conclude the researchers, "open a fundamentally new paradigm for clinical approaches that include in vivo stone dissolution." Rheumatoid Arthritis What to know about rheumatoid arthritis during pregnancy (Medical News Today: ) How does RA affect pregnancy? Do symptoms improve? Risks Fertility What to expect after birth Takeaway Women with rheumatoid arthritis often notice changes in their symptoms during pregnancy. Many women with this condition have fewer symptoms when they are pregnant, but some may experience a flare during this period. Rheumatoid arthritis (RA) is a long-term disease that primarily affects the joints, causing them to swell, stiffen, lose function, and ache. People can have RA in any joint, but it most commonly affects the wrists and fingers. RA affects more women than men and often develops before menopause. Doctors may need to adjust a woman's RA treatment during pregnancy to continue to manage flares without causing any harm to the developing fetus. In this article, learn about how RA and pregnancy can affect each other, the potential risks of being pregnant with RA, and what to expect after birth. How does RA affect pregnancy? Rheumatoid arthritis and pregnancy Pregnant women with RA may have an increased risk of preeclampsia, premature delivery, and low birth weight. One study found the rate of pregnancy loss in women with RA to be 17 percent. The researchers note that this rate is comparable to that of the general population, which is percent.

16 However, pregnant women with RA may have an increased risk of the following complications: Preeclampsia: According to a Taiwanese study, women with RA have an increased risk of preeclampsia. Preeclampsia is a pregnancy complication that causes high blood pressure and an excess of protein in the urine. It can also occur after childbirth. Premature delivery: According to some research, pregnant women with RA may be more likely than those without the disease to give birth prematurely. A study of 440 pregnant women with RA showed that women with more severe symptoms of this condition had a higher risk of premature delivery. Low birth weight: A study from 2009 found that women with more severe RA had a higher likelihood of having underweight babies. Women with RA who get pregnant may experience symptoms that are common to both pregnancy and RA. Sometimes it can be challenging to distinguish which of the conditions is causing the symptoms. These symptoms may include fatigue, shortness of breath, swollen hands and feet, numbness or pain in the hands, and joint pain, particularly in the lower back and hips. Can symptoms improve during pregnancy? Rheumatoid arthritis and pregnancy pain Women with RA may experience fewer symptoms during pregnancy. During pregnancy, changes take place in the immune system to prepare the body to nurture the developing fetus. Approximately 50 percent of women with RA experience fewer RA symptoms during pregnancy, which doctors refer to as low disease activity. Joint swelling and pain usually improve during the second trimester of pregnancy. Around percent of women with RA have few or no symptoms of the disease by the third trimester. However, 20 percent of women have severe or worse RA symptoms during pregnancy and may require medical treatment. How can I sleep with rheumatoid arthritis? RA may make it difficult to sleep, causing extra fatigue in the daytime. Learn how to get a good night's sleep with RA here. Risks Women with RA can have successful pregnancies and deliver healthy babies. However, delivery may be more difficult in cases where RA affects a woman's hips or lumbar spine.

17 Although the risks for the woman and the baby are low, women with RA who wish to conceive should speak to a doctor before trying to get pregnant. Some RA medications may affect the pregnancy or the fetus. The doctor may recommend that a woman stops or replaces some medications before trying to get pregnant or as soon as she discovers that she is pregnant. RA and fertility Rheumatoid arthritis and pregnancy doctor Women with RA should speak with a doctor regarding their medication and the best time to try to conceive. Women with RA may have more difficulty conceiving than women without the condition. This may be due to the effects of RA, the use of some RA medications, or both. As a result, it is vital for women with RA who wish to conceive to speak with their doctor about the medications that they are using and the best time to try to get pregnant. The doctor may recommend aiming to time a pregnancy with a period of remission and stopping certain medications to increase the chance of conceiving. What to expect after birth Many women with RA will experience a flare shortly after birth, often within 3 months. If this occurs, it is best to speak with a doctor about which medications are safe to use to manage the symptoms. Doctors usually also encourage breastfeeding, as this offers many benefits for both the woman and the infant. They may recommend medications that are safe for the baby or will not pass into the breast milk. Takeaway Many women experience a reduction in their RA symptoms during pregnancy but may have a flare after childbirth. The risk of pregnancy complications is slightly higher for women with RA than for other women. Doctors may recommend changing medications before trying to get pregnant or as soon as a woman becomes pregnant. With careful planning and advice from a doctor, women with RA can have a successful and healthy pregnancy and delivery.

18 Leukemia Leukemia rash pictures (Medical News Today: ) Leukemia is a type of cancer that affects white blood cells. Symptoms include nausea, fever, and anemia. People with leukemia can also experience skin-related issues, such as a rash. The majority of rashes have no link to cancer and should resolve without treatment or with overthe-counter medication. Leukemia impairs the development of white blood cells and causes them to stop functioning correctly. Unlike healthy cells, the affected cells do not die when they should. Instead, they continue spreading, eventually overcrowding the healthy cells in the blood. In addition to a rash, leukemia can cause a range of symptoms, including: nausea fever flu-like symptoms frequent infections anemia bone pain fatigue unexpected weight loss poor blood clotting Leukemia rash pictures Leukemia can cause tiny blood vessels called capillaries to burst underneath the skin. When leukemia progresses to a certain point, the multiplication of abnormal blood cells disrupts the production of platelets. As a result, there may not be enough platelets to block any burst capillaries, and blood can leak out into the skin. This leakage can cause tiny red, purple, or brown spots called petechiae to emerge on the skin. Small collections of these petechiae can form, giving the appearance of a rash. graphic image warning for carousel

19 tiny red spots Petechiae AML rash <br>image credit: Dermnet.nz</br> Image credit: Dermnet.nz Other rashes Bruises 1of6 A method that people can use to distinguish petechiae from a rash is to press down on the affected area of skin using a finger or thumb. Petechiae will not change color, but a rash will turn white. Other skin symptoms Having an insufficient number of healthy blood cells can cause a range of other skin problems, including: Easy bruising People with leukemia are more susceptible to bruising, even from small knocks. Without enough platelets in the blood, the body cannot prevent blood vessels from bleeding under the skin upon injury. These bruises are not the same as petechiae and look like regular bruises. Easy bleeding In people with leukemia, abnormally large amounts of blood tend to escape from cuts and other skin wounds. Even the smallest injuries can cause bleeding at the surface of the skin. Again, this is due to the lack of platelets available to form a blockage and stop blood escaping from the wound. What are the early symptoms of leukemia in children? Leukemia is a common type of cancer in children. Spotting the symptoms can allow people to get treatment earlier, which can improve the outlook. Learn more about the symptoms of leukemia in children here. Pale skin People with leukemia can also develop anemia.

20 Anemia is a condition in which a person has an abnormally low red blood cell count, which can cause the skin to appear pale. Red blood cells contain a protein called hemoglobin, which carries oxygen from the lungs to the rest of the body. A reduction in hemoglobin lowers the amount of oxygen circulating in the body, which can have severe effects. The main symptom of anemia is chronic fatigue, but this condition can also cause: difficulty breathing chest pains headaches dizziness abnormal blood pressure When to see a doctor Rashes and other skin problems are widespread and often no cause for concern. However, people with more persistent rashes that may be petechiae should see a doctor immediately as identifying the cause of the rash is crucial. A range of conditions other than leukemia can cause petechiae. It is vital for a doctor to examine the skin and determine the severity of the condition. Takeaway Some people may always bruise or bleed more easily than others as a result of genetic factors. However, anyone who notices that they have started bruising or bleeding more easily than they did previously should see a doctor. These symptoms may signify a medical condition, such as leukemia. As with any cancer, the early detection of leukemia is crucial to the success of treatment. There will be an estimated 60,300 new cases of leukemia in the United States in The relatively high incidence of this disease means that it is necessary for people to be cautious and discuss any doubts or uncertainties with a doctor.

21 Diabetes Is it safe for a person with diabetes to eat sweets? (Medical News Today: ) Eating sweets as part of a healthful diet Types of sugar Sugar substitutes Reading a nutrition label Takeaway Diabetes is a chronic condition that causes a person's blood glucose levels to become too high. Although people with diabetes often need to carefully manage their diet, incorporating the occasional sweet or sugary food into a healthful diet can still be okay. There is a popular misconception that people with diabetes must avoid all sweets and sugary foods. Carefully monitoring the carbohydrates and sugars a person eats is vital because of the impact it can have on blood glucose, or sugar, levels. However, it is still possible to eat sweets or sugary food, as long as it is part of a healthful diet plan. In this article, we look at eating sweets as part of a healthful diet, types of sugars and sugar substitutes, and how to read the nutrition label on food packaging. Eating sweets as part of a healthful diet Woman eating chocolate and considering if diabetics can eat sweets People with diabetes should consider sugary foods to be a treat and eat them in small portions. The amount of carbohydrate and sugars a person with diabetes can eat depends on factors, including: their activity levels whether they are trying to lose weight or maintain a healthy weight whether they are trying to lower their blood glucose levels A doctor or dietician can help people set personal goals and advise on a diet plan to suit their needs. According to the American Diabetes Association, people with diabetes can still have sweets, chocolate, or other sugary foods as long they are eaten as part of a healthful meal plan or combined with exercise. They consider a healthful meal plan to: have limited saturated fat

22 contain moderate amounts of salt and sugar include lean protein, non-starchy vegetables, whole grains, fruits, and healthy fats However, it is best to save sugary foods for an occasional treat and enjoy them in small portions. When choosing any food, it is essential for a person with diabetes to understand how it can affect their blood glucose levels. Knowing how to read the nutrition labels on food packaging can make this easier. Many foods claim to be "sugar-free" or have "no added sugar." However, these foods can still contain calories and types of carbohydrate that can impact a person's blood sugar levels. Types of sugar There are three main types of carbohydrates: simple carbohydrates, or simple sugars complex carbohydrates, or starches fiber, which is from plant foods and mostly indigestible Both natural and added sugars are in foods. Examples of natural sugars include: fructose, which is in fruits lactose, which is in dairy products There are more than 60 different names for added sugar on the ingredients list of food labels. Some common names include: sucrose, also known as table sugar high-fructose corn syrup corn syrup brown rice syrup agave nectar honey maple syrup maltose dextrose malt syrup

23 glucose maltodextrin barley malt beet sugar When a person eats, their digestive system breaks down the carbohydrates from the food into glucose, which is a simple sugar. The body then absorbs this glucose into the bloodstream. Glucose is the body's primary energy source. A hormone called insulin tells the body's cells to absorb glucose from the blood. People with diabetes either do not produce enough insulin or their cells do not respond to the hormone appropriately. This causes blood glucose levels to become too high. Simple sugars tend to raise blood glucose levels faster and higher than complex carbohydrates, such as whole wheat and oatmeal. Sugar substitutes women pouring sweetener into coffee Artificial sweeteners can contain calories and carbohydrates. Sugar substitutes are low or no-calorie alternatives to sugar that usually have less impact on a person's blood glucose levels. Manufacturers commonly add them to many foods, especially products they describe as "low sugar," "reduced sugar," "diet," or "low calorie." However, other ingredients in these products may still contain calories or carbohydrates. Before purchasing one of these reduced-sugar products, it is important to check the label for nutrition details. Sugar substitutes may also cause someone to eat more food later on. They can also possibly alter a person's sense of taste so that they find naturally sweet foods less appetizing. Common types of sugar substitutes include: Artificial sweeteners Artificial sweeteners, also known as nonnutritive sweeteners, are synthetic sugar substitutes that typically contain no or very few calories. According to the American Diabetes Association, the U.S. Food and Drug Administration (FDA) have approved six artificial sweeteners: aspartame

24 acesulfame potassium or acesulfame k saccharin sucralose neotame advantame People can also buy many of these artificial sweeteners to use as substitutes for table sugar or in cooking and baking. Which foods lower blood sugar? One way to control blood glucose levels is to eat foods with a low glycemic index. Learn more here. Sugar alcohols Sugar alcohols are a type of carbohydrate found naturally in plants. But, manufacturers need to process them before they can add them to foods as sweeteners. Sugar alcohols have fewer calories than regular sugar but can still increase a person's blood glucose levels. Common sugar alcohols include: sorbitol mannitol xylitol erythritol maltitol isomalt lactitol In some people, sugar alcohols can have a laxative effect, which can cause diarrhea and gas. Stevia Stevia is a "generally recognized as safe" or GRAS sweetener that is naturally present in the Stevia rebaudiana plant. However, manufacturers need to extract and purify the sweetener, using a chemical process. Stevia is also known as Rebaudioside A, Reb-A, or rebiana.

25 Stevia contains no sugar or calories and manufacturers add it to many different food and drink products as a sugar substitute. These products may describe themselves as being "naturally sweetened." Stevia is also available as a tabletop sweetener. Stevia sweeteners are available to purchase online. Monk fruit The monk fruit, or luo han guo, is a plant native to Southeast Asia. The juice from monk fruit is extremely sweet, around times sweeter than table sugar. Manufacturers add it to a range of foods and drinks as a sugar substitute. Similarly to Stevia, monk fruit extract is a GRAS sweetener, contains no sugar or calories, and products containing it may describe themselves as "naturally sweetened." Monk fruit is also available as a tabletop sweetener. Monk fruit sweeteners are available to purchase online. Reading a nutrition label nutrition label and facts In the U.S., all packaged food and drink products display a Nutrition Facts label. Knowing how to read this label can help people determine the potential impact food or drink may have on their blood glucose levels. There is often a multitude of information on a Nutrition Facts label, but the three most important numbers are: serving size total carbohydrates calories We discuss each of these below. Directly below the Nutrition Facts box, food packaging usually features an ingredients list. If a food product contains any artificial sweeteners or other sugar substitutes, the manufacturer will include them in this list. Serving size The first figure to look at on a Nutrition Facts label is the serving size. Manufacturers base all other information on one serving of the food. For example, a box of crackers may list 10 crackers as one serving. So, if someone eats 20 crackers, they will be consuming twice the calories and carbohydrates stated on the box.

26 Manufacturers base the serving size on common household measures that are appropriate to the food, such as: cups tablespoons pieces slices jars The label will also always include the serving size in grams (g) and the number of servings per container. Calories On a Nutrition Facts label, the calories figure refers to the total number of calories in one serving. These calories come from all sources, including fat, carbohydrate, protein, and alcohol. Knowing the total calories consumed each day can be important for people wanting to lose weight or maintain a healthy weight. To lose weight, people need to eat fewer calories than they burn by physical activity and metabolic processes. Anyone who wishes to lose weight should speak to a doctor or dietician for advice on a diet plan. Total carbohydrates The figure for total carbohydrates states the amount of carbohydrate in grams in one serving. This number includes sugar, complex carbohydrate, and fiber. For people with diabetes, it is critical to consider the total amount of carbohydrate and not just sugar. All types of carbohydrate can affect blood glucose levels. Some foods may contain little or no sugar but a lot of carbohydrate. By looking at just the amount of sugar on a label, a person may end up underestimating the food's potential impact on their blood glucose. Food manufacturers will sometimes also use terms such as "net carbs," "impact carbohydrate," or "digestible carbohydrate" on their packaging. The FDA and the American Diabetes Association do not recognize these terms because they can be misleading about the total carbohydrates in a product. Manufacturers often calculate these figures by subtracting the quantity of sugar alcohol and fiber from the total carbohydrate. But this method can give the impression that the product has less carbohydrate than it does.

27 People with diabetes should always look at the total carbohydrate amount when determining whether or not to eat a particular food. Takeaway People with diabetes can have sweets and other sugary foods as part of a healthful meal plan or when combined with exercise. However, it is best to enjoy sweets in small portions as an occasional treat. When choosing any food, it is important to read the nutrition label and be mindful of how the amount of total carbohydrates can affect a person's blood sugar levels. We picked linked items based on the quality of products, and list the pros and cons of each to help you determine which will work best for you. We partner with some of the companies that sell these products, which means Healthline UK and our partners may receive a portion of revenues if you make a purchase using a link(s) above. fɬ fɬ ȧर कथ म (Dainik Tribune: ) %E0%A4%B8-%E0%A4%95%E0%A5%80%E0%A4%B0%E0%A5%8B%E0%A4%95%E0%A4%A5%E0%A4%BE%E0%A4%AE/ अभ म जल ह बह त दर ǓǕ ȡक तम म ȯ ɉक f f ɬ ȧभय वहत ȡ ȧकम ह गई ह [1990 क ] Ȳ ɉस Ǒ त लन Ʌत 2017 Ʌ^ Ʌ ȡ ȧकम प ई गई ह ȡçĚȣ f ɬ अब f ɬ क Ǔ Ȳğ स गठन न Ȫ ȡह ȲĐ Ĥ ȡ Ʌ80 ĤǓ तक ȧकम आई ह, जसक क रण समय रहत र ग ȧपहच न और इल ज Ȫ ɉ ȣ ɇ@इन Ȫ ɉक चलत f ɬ ह एक तरफ त इस स ह न ȡ ȣ Ǚ Ǖदर Ʌ ȡ ȧकम आई ȶ न Ʌर हत ȣ ह, भ अभ ǐ ǔè Ǔ ȡȲ ȡ ȧ Ȳ ȡ ɇ È ɉ भ रत एचआईव य f ɬ स ȲĐ Ȫ ɉ ȧ ȲÉ ȡ Ʌ æ Ʌत सर न बर पर ह f ɬ एचआईव क ȡ ɉ Ʌसबस Ï ȡ ȡĤ ȡ ȯ ɉ Ʌ \ ĥ ȧ ȡपहल न बर पर और ȡ^ Ȣǐ ȡ

28 दस र न बर पर ह यह भ ह एचआईव ȲĐ स बच व क ज ê रख गय थ, हम उसक आसप स भ ȣȳपह च प ए ȣ ȣ,ȳ Ǒ ȡj Ȳ Ʌएचआईव रह ɇ, जसक क रण ǕÉ ȡ Ȫ ɉ Ʌ Ǖ ȡ ȣǐ ȲĐ क म मल बढ़त ज Ȳ Ȳ ɉक ब बत \ ȡह Ú ȡ द न ȪÊ ब त यह ह ` - Ǘ ȸ Ĥ ȯ ɉ ज स Ȫ, Ǖ और ȡ ȡ ɇ Ʌएचआईव ȲĐ ȧसबस Ï ȡ ȡआश क ह अभ ह ल ȣ Ʌउ.Ĥ. Ʌ` Û ȡ क ब गरमऊ ȯğ Ʌएक झ ल छ प ȨÈ क 58 Ȫ ɉक एचआईव स ȲĐ करन क आर प Ʌपकड़ गय थ इस तरह क ȯ ɉ ȧ Ǖ ȡ ǔǚ र कन ह ग è ȡèØ स व ए Ĥ ȡ करन व ल सभ Ȫ ɉक ȡ Ǿ करन ह ग È ɉ Ǘ Ⱦ ȡÏ ɉ Ʌ भ इस तरह ȧ ȲĐ Ǘ^ ɉ क Ĥ Ȫ ȡ ज रह ह, जह झ ल छ प ȨÈ ɉ क ȡĨ ȡÏ ह और ȪÊ ɉऔर ȡ Ǿ ȡक अभ व Ʌ Ȣ ȡǐ ȡȲअपन प र पस र ȣ ɇ@ऐस Ʌ इस भय वह र ग स Ǔ ȯ Ʌसफलत ȧ क छ स भ वन ए Ǒ ȯलग ɇ, Ʌअपन Ĥ ȡ ɉ Ʌ Ǒ ȡ_ ȣȳकरन ȡǑ f और न ȣइस ȡ [क ह त धन आव टन Ʌक ई कम ह न ȡǑ र क यह ǕǓ ǔæ करन ȡǑ f अब इस र ग स हम Ǘ ȣतरह Ǔ ȡ प कर ȣ Ʌ ȯ@ जसक f समय-समय पर ȡ Ǿ ȡ\ ȡ चल और ȡ[Ü è ȡèØ स व ए Ĥ ȡ कर ई ज ए

29 Drug News (Hindustan Times: )

30 Cancer and Infertility (Hindustan: )